Behavioral Healthcare in Pediatrics (BeHiP) Michelle Fiscus, MD - - PowerPoint PPT Presentation

Behavioral Healthcare in Pediatrics (BeHiP)

Michelle Fiscus, MD FAAP Immediate Past President, TNAAP Medical Director, BeHiP Program

The view from 30,000 Feet

Michelle Fiscus, MD FAAP

A Brief History of BeHiP…

• BCBS asked TNAAP to assist with training and engagement for

providers caring for children in foster care—”Best Practice Network” (BPN) providers

• Saw need for statewide system of care for behavioral health
• 2012 began training physicians statewide to screen for,

discuss, and manage pts with BH concerns

• 2014 began training physicians in trauma-focused care,

medical mgmt

• 2016 began working on behavioral health care learning

collaborative for providers caring for children in foster care

– Modeled (loosely) after MCPAP program

Ultimate goal: Statewide system of care around pediatric behavioral health

BeHiP 3 Pilot Logic Model

Resources Activities Outputs Short Term Outcomes Long Term Outcomes

• Community

pediatricians

• Community

partners

• Regional DCS
• Regional COE
• BlueCare
• TNAAP
• Training
• PDSA/MOC4
• Data collection
• Video

collaborative

• Formation of

BeHiP network

• Create foster

care system care coordination model

• # physicians

impacted

• # system

changes made

• # PDSA cycles

completed

• # video

sessions completed

• # foster

children impacted

• Stakeholder

engagement

• Improved

payment

• Networking
• Coalition

building

• Improved

patient care

• Sustainable

regional BH collaborative network

• Improved PCP-

provided BH care to all patients

• Improved BH

collaboration & referral

• Reduced cost
• Reduced

inappropriate medication use

• Improved
• verall

healthcare for children

Primary Chronic Disease Incidence and Cost for Children in Foster Care

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32.0% 12.3% 6.4% 9.6% 4.4% 2.8% 3.4% 1.1% 0.7% 0.4% 30.3% 11.6% 8.7% 7.4% 5.4% 3.0% 2.8% 1.2% 0.8% 0.5%

Percent of Total Paid Dollars

Period 1 Period 2 37.3% 9.9% 0.5% 2.6% 4.3% 0.6% 1.7% 0.7% 0.2% 0.1% 37.4% 9.0% 0.5% 2.4% 5.9% 0.5% 1.8% 0.8% 0.2% 0.1%

Percent of Members

Period 1 Period 2

Behavioral/Chemical Dependency Asthma Congestive Heart Failure Cancer Obesity Neurology Cardiovascular Disease Diabetes Trauma Hematology

Top 10 Chronic Conditions

BCBST and the Tennessee Chapter of the American Academy of Pediatrics

Behavioral Health Prescriber Locations in the BlueCare Network

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

BlueCare TN Best Practices Network

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

The Mental Health Challenge

• 1 in 5 US children have emotional/behavioral

symptoms causing impairment

• 1 in 5 ages 13-18 have a mental illness
• 1 in 2 adults with mental illness had symptoms

by age 14

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

The Mental Health Provider Shortage

• In 1990, estimated need for >30,000 child

and adolescent psychiatrists by 2000

(Committee on Graduate Medical Education)

• In 2013, there were 8,000 (AMA 2013)

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

Practicing Child & Adolescent Psychiatrist by State

BCBST and the Tennessee Chapter of the American Academy of Pediatrics

A Primary Care Solution

• Primary Care Providers (PCPs) are often the first

point of contact for families with behavioral health concerns

• PCPs are frequently in the best position to

identify and discuss behavioral health concerns with families

BCBST and the Tennessee Chapter of the American Academy of Pediatrics

BeHiP I

Increase pediatrician confidence and competency in:

• Screening
• Talking to patients and their families
• Understanding treatment
• Knowing when, how, and to whom to refer a patient
• Networking

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

HEL2P3

Hope Empathy Language, Loyalty Permission, Partnership, Plan

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

BeHiP I

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• 5 face-to-face regional trainings across Tennessee
• 1 BEHIP introductory training video
• 6 Guidance Videos
• Anxiety
• Inattention and impulsivity
• Depression
• Disruptive behavior and aggression
• Social/emotional guidance for children birth to age 5
• Substance use and abuse

BCBST and the Tennessee Chapter of the American Academy of Pediatrics

Results

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

BeHiP II

Raise pediatrician confidence and competency in:

– Trauma-informed care – Adverse Childhood Events (ACEs) – Navigating the Department of Children’s Services (DCS) – Basic psychopharmacology – Treating v. referring – Networking

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

Psychopharmacology

• 9% of children and adolescents prescribed

psychotropics

• Children in foster care prescribed

psychotropics 3-11 times more than Medicaid children not in foster care

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

Primary Care Psychopharmacology

PCPs

• Provide >50% of US mental health care
• Prescribe >75% of the anxiolytics, antipsychotics,

and mood stabilizers

• Beyond stimulants, many PCPs are

uncomfortable with prescribing psychotropic medications

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Magellan Health Services (2013): Appropriate Use of Psychotropic Drugs in Children and Adolescents BCBST and the Tennessee Chapter of the American Academy of Pediatrics

BeHiP II

• Transition BeHiP I content to online

modules

• 5 face-to-face regional

trainings/networking events

• Transition BeHiP II content to online

modules

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

Results

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

BeHiP III

Behavioral Health Integration Pilot Project

– Identify providers – Train providers – Build relationship between providers and their COEs – Create a telemed learning collaborative – Replicate

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

What are COEs?

• Part of a statewide network to enhance the

quality of services provided to children in or at- risk of entering the Tennessee child welfare or juvenile justice systems

• Children and families are more likely to have

developmental, physical, or psychiatric disabilities, and ACEs

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( Vanderbilt COE Website) BCBST and the Tennessee Chapter of the American Academy of Pediatrics

Centers of Excellence for Children in State Custody (and at risk of custody)

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics

Key Takeaways

• Collaboration between BCBS and state chapters of professional

societies such as AAP can result in solutions to healthcare challenges

• Raising the confidence and competency of pediatricians around

behavioral health concerns is critical to bridging gaps in access to care

• Identifying barriers at the provider level and fostering relationships

between providers and regional resources is crucial to sustaining change

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BCBST and the Tennessee Chapter of the American Academy of Pediatrics